Chastagner P, Sommelet D
Médecine infantile II, Hôpital d'enfants, Vandoeuvre-lès-Nancy, France.
Pediatrie. 1991;46(1):47-58.
Chemotherapy is a treatment of choice for children with brain tumors, since 20% are unresectable (hypothalamic and brainstem), or incompletely removed, and since radiation therapy often induces cognitive and endocrine sequellae. However, tumor cell heterogeneity and blood-brain barrier which play a role in restricting delivery of chemotherapy represent limiting factors to its efficiency. Neuroradiological procedures such as CT scan and magnetic resonance imaging may bring objective criteria in order to evaluate the efficacity of chemotherapy. Chemotherapy is tested in phase II trials to identify the most efficient drugs for each histological tumor type. This provides a rationale to elaborate phase III trials where polychemotherapy is combined to surgery and radiotherapy. Attempts to enhance drug penetration, such a high-dose chemotherapy and blood-brain barrier disruption, are under study. Primary and acquired drug resistance are being studied as well as the means of overcoming them.
化疗是脑肿瘤患儿的首选治疗方法，因为20%的肿瘤无法切除（下丘脑和脑干肿瘤）或切除不完全，而且放射治疗常引发认知和内分泌后遗症。然而，肿瘤细胞异质性和血脑屏障在限制化疗药物递送方面发挥作用，这是化疗效率的限制因素。诸如CT扫描和磁共振成像等神经放射学检查方法可为评估化疗疗效提供客观标准。在II期试验中对化疗进行测试，以确定针对每种组织学肿瘤类型最有效的药物。这为开展III期试验提供了理论依据，在III期试验中，联合化疗与手术及放疗。提高药物渗透的尝试，如大剂量化疗和血脑屏障破坏，正在研究中。原发性和获得性耐药性以及克服它们的方法也正在研究中。
